BARRIERS PATIENTS FACE IN INCREASING HEMODIALYSIS FREQUENCY – A NATIONWIDE CROSS-SECTIONAL STUDY IN INDIA, 2023

Introduction:

The prevalence of hemodialysis (HD) patients significantly lags the true demand for end-stage kidney disease treatment due to socioeconomic factors, distance, and other barriers. Even among those who have access to dialysis, HD frequency is often less than the recommended thrice weekly, 4-hour sessions. The objective of this study is to study the prescription patterns of HD frequency by Nephrologists and identify the barriers patients on hemodialysis face in undergoing hemodialysis sessions as per the prescribed frequency.

Methods:

We conducted a nationwide cross-sectional study in 35 hemodialysis centers selected randomly from a single large private network that provides maintenance hemodialysis services in India. The study period was from September to December 2023. The total sample size was 2214. All patients who underwent HD in the selected centers and who consented to participate were included. The data was collected at the bedside, by trained dedicated staff present in the hemodialysis centre using a laptop or a tablet. Data entry was done in a Google form and exported to Excel for analysis. We describe the basic demographic characteristics and reasons for patients to undergo HD sessions at a lower frequency than prescribed.

Results:

Among 2214 participants, the mean age was 53.15 ± 14.47 (range: 18 to 91) years, majority of them were male (72%). The centres chosen were 49% from the south zone, 36% from north and 15% from west. 47% of the centres were located inside government hospitals and 53% were within private hospitals. 79% of the patients were covered by a government program, 5% by private insurance and 16% paid their medical expenses out-of-pocket. The proportion who was prescribed 3, 2 and 1 sessions per week were 55%, 43% and 2% respectively. Among them, 50% underwent 3 sessions, 47%, 2 sessions and 3%, 1 session per week. Overall, 93% were taking as many sessions as prescribed by the doctor and 7% were taking fewer sessions than the number they were prescribed. Distribution of cause of lower frequency as given by patients: 53% believed there was no need for a higher frequency of sessions, 15% could not afford more frequent treatments, 14% stayed too far from the centre, 8% had inadequate family support to travel for HD, 8% felt tired after a dialysis session, 6% couldn’t take more time off from work, 4% responded that dialysis was too uncomfortable and 3% blamed the pain due to vascular access cannulation (Figure 1).

Conclusions:

This study provides valuable insights into the patients’ mindset on deviation from prescribed dialysis frequency. Affordability, distance to the centre and symptoms associated with HD were other major limitations for lesser than the prescribed HD frequency. Better education about the need for regular dialysis could go a long way in improving adherence.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.